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Successful Implementation of a Window for Routine Antimicrobial Prophylaxis Shorter than That of the World Health Organization Standard

Published online by Cambridge University Press:  02 January 2015

Heidi Misteli ,
Andreas F. Widmer ,
Walter P. Weber ,
Evelyne Bucher ,
Marc Dangel ,
Stefan Reck ,
Daniel Oertli ,
Walter R. Marti  and
Rachel Rosenthal
Heidi Misteli*
Affiliation:
Division of General Surgery, University Hospital of Basel, Basel, Switzerland
Andreas F. Widmer
Affiliation:
Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
Walter P. Weber
Affiliation:
Division of General Surgery, University Hospital of Basel, Basel, Switzerland
Evelyne Bucher
Affiliation:
Division of Anesthesiology, University Hospital of Basel, Basel, Switzerland
Marc Dangel
Affiliation:
Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
Stefan Reck
Affiliation:
Division of General Surgery, University Hospital of Basel, Basel, Switzerland
Daniel Oertli
Affiliation:
Division of General Surgery, University Hospital of Basel, Basel, Switzerland
Walter R. Marti
Affiliation:
Division of General Surgery, Kantonsspital Aarau, Aarau, Switzerland
Rachel Rosenthal
Affiliation:
Division of General Surgery, University Hospital of Basel, Basel, Switzerland
*
Department of General Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland (mistelih@uhbs.ch)
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Abstract

Objective.

To evaluate the feasibility of implementation of the refined window for routine antimicrobial prophylaxis (RAP) of 30-74 minutes before skin incision compared to the World Health Organization (WHO) standard of 0-60 minutes.

Design.

Prospective study on timing of routine antimicrobial prophylaxis in 2 different time periods.

Setting.

Tertiary referral university hospital with 30,000 surgical procedures per year.

Methods.

In all consecutive vascular, visceral, and trauma procedures, the timing was prospectively recorded during a first time period of 2 years (A; baseline) and a second period of 1 year (B; after intervention). An intensive intervention program was initiated after baseline. The primary outcome parameter was timing; the secondary outcome parameter was surgical site infection (SSI) rate in the subgroup of patients undergoing cholecystectomy/colon resection.

Results.

During baseline time period A (3,836 procedures), RAP was administered 30–74 minutes before skin incision in 1,750 (41.0%) procedures; during time period B (1,537 procedures), it was administered in 914 (56.0%; P < .001). The subgroup analysis did not reveal a significant difference in SSI rate.

Conclusions.

This bundle of interventions resulted in a statistically significant improvement of timing of RAP even at a shortened window compared to the WHO standard.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 9 , September 2012 , pp. 912 - 916
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012 

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